CRISIS: Dr David McDougall outside The Family Practice Medical Centre in Bundaberg, which may have to close if he cannot recruit a GP.
CRISIS: Dr David McDougall outside The Family Practice Medical Centre in Bundaberg, which may have to close if he cannot recruit a GP. Mike Knott BUN230517BULK3

SPECIAL INVESTIGATION: Why we have a GP shortage

THE ISSUES

BUNDABERG faces two issues when recruiting doctors to the area.

1. The first is the classification called the District of Workforce Shortage. A DWS is an area where the ratio of doctors to patients falls below the average.

Bundaberg and surrounding areas including Moore Park Beach and Burnett Heads are not included in the DWS.

Areas that fall outside this classification must adhere to much more stringent criteria when recruiting a GP.

An Australian-trained doctor can set up a medical practice here and receive Medicare subsidies, however doctors trained overseas are not eligible and must bill patients privately.

The DWS is reviewed by the Federal Government.

2. The second issue is remote classification. Currently Bundaberg is not considered as remote as places such as Hervey Bay and Gympie. This means bulk billing doctors in these areas are being paid almost double.

This discrepancy means doctors are more likely to set up in those areas.

DOCTOR'S SURGERY STAFF WORRIED WHERE PATIENTS WILL GO

THEY'RE staring down the barrel of retrenchment, yet their only concern is for the many patients who will have nowhere to go.

Stockland Family Practice Medical Centre could be closed by the end of June if director Doctor David McDougall is unable to find a doctor to replace the three who are leaving.

A problem with remote classification that sees doctors in regions to the south such as Hervey Bay and Gympie receiving almost double the pay of their Bundaberg counterparts - combined with Bundaberg's exclusion from the District of Workforce Shortage - has made recruiting doctors to the region near impossible.

DOCTOR SHORTAGE: Gaye Howie, Melinda Dexter, Jareena Godugu and Hayley Brookes outside The Family Practice Medical Centre, which may be forced to close.
DOCTOR SHORTAGE: Gaye Howie, Melinda Dexter, Jareena Godugu and Hayley Brookes outside The Family Practice Medical Centre, which may be forced to close. Mike Knott BUN230517BULK2

Stockland practice manager Gaye Howie has been with the medical centre for 12 years and says the three receptionists, four nurses and doctors were "like family”.

"We've been through a lot. I've got nurses who have been here 10 years. One of the receptionists eight or nine years, or even longer,” she said.

"For the last couple of years, we've been running low (on doctors).

"We care about our patients. I'm not worried that I'm not going to have a job - where our are our patients going to get their continuous care?”

Mrs Howie says some of the staff have mortgages to pay but "they feel the same way ... our main concern is the patients”.

She said an advertising campaign asking people not to go to emergency departments with minor complaints and instead see their GP was illogical.

"Where do these patients go if there's no local GP?,” she said.

Mrs Howie said as news of the surgery's plight broke, patients were quick to offer support.

"We've had a few patients coming in and asking, 'what can we do?',” Mrs Howie said.

"I think the patients are willing to support us, but what can they do?”

Mrs Howie said the centre's sister practice at Hinkler would try to take as many patients as they could, but they too were stretched.

One of the problems with not being able to retain doctors was continuous care, especially for elderly patients who had complicated conditions, she said.

She's certain the blame lies at the feet of the Federal Government.

"They need to take responsibility,” she said.

PHARMACIST SAYS THEY NEED CHANGE NOW

IT TOOK two years of cold calling doctors up and down the coast before Moore Park Beach pharmacist Adam Harradine found one willing to come to the area.

Then just nine months later, due to an unfortunate family emergency overseas, the doctor's surgery was closed once again.

It's an untenable situation that Mr Harradine says needs urgent attention but so far his pleas have fallen on deaf ears.

ACTION NEEDED: Pharmacists Adam Harradine and Dwight Kakazu outside the Northstar Medical Centre in Moore Park.
ACTION NEEDED: Pharmacists Adam Harradine and Dwight Kakazu outside the Northstar Medical Centre in Moore Park. Mike Knott BUN250517DOCTOR1

Mr Harradine has been petitioning for three to four years to have the area declared a District of Workforce Shortage and says this would make recruiting a GP far easier.

"We've had a lot of difficulty trying to recruit doctors to Moore Park,” he said.

"Not that there's not the patient base, just in contrast to other areas that are DWS-approved, we can only recruit from a limited pool of doctors.

"We are not an area of DWS because the government doesn't deem that we need a doctor out here, so without a DWS classification, we can only recruit an Australian-trained doctor to open a practice.

"Agnes Water and Gin Gin are DWS classified, so they can recruit any doctor, Australian-trained or otherwise, to open a surgery and it's a little bit easier for them to get a doctor.

"Moore Park Beach, you're only ever going to have one doctor, so from the get-go that doctor has to meet the criteria,” he said.

CHANGE NEEDED: A graphic showing the current District of Workforce Shortage mapping.
CHANGE NEEDED: A graphic showing the current District of Workforce Shortage mapping. Hayley Nissen

Mr Harradine said when the medical practice was open, there was support for it from the community.

"He opened for two days a week and within weeks his surgery was full four days a week,” he said.

"So it wasn't a lack of patients.”

Mr Harradine said the community backing was there for a GP and he had the support of the Moore Park Beach Community Association as well as Member for Burnett Stephen Bennett, but it was now time for the Federal Government to act.

"Everyone is on the same page except the Minister for Health,” he said.

"I got a letter back from Greg Hunt's office that stated we have options for recruiting doctors to Moore Park Beach but obviously that hasn't worked over the last four to five years and we need a change and we need it now,” said a frustrated Mr Harradine.

"My primary objective is to have Moore Park Beach assigned a different DWSAA (DWS Assessment Area) than the rest of Bundaberg.

"This would then assess the need for a doctor in Moore Park Beach (and its surrounding suburbs, such as Welcome Creek and Gooburrum) solely, rather than aggregating the results with that of Bundaberg.”

In a letter of reply to Mr Harradine from Mr Hunt's office, a spokesman said the department did not make discretionary determinations and they had the option to employ an overseas-trained doctor on a short-term basis.

"You continue to have options for recruiting additional doctors to Moore Park Beach. These options include the employment of OTDs as short-term locums,” the letter read.

Mr Harradine has also been in contact with Member for Flynn Ken O'Dowd but had little luck in moving forward.

DOCTORS ALREADY GONE AT BURNETT HEADS

THE news that a Bundaberg medical practice will have to close its doors if it cannot find a doctor in the next month isn't a surprise to the community of Burnett Heads.

The town is without a general practitioner, despite there being a building dedicated to that purpose.

Burnett Heads Progress Association president Chris McLoughlin said the time for change was now.

NOT GOOD ENOUGH: Burnett Heads Progress Association president Chris McLoughlin says more must be done.
NOT GOOD ENOUGH: Burnett Heads Progress Association president Chris McLoughlin says more must be done. Hayley Nissen

"The media coverage of the doctor shortage in Bundaberg and the need to change Medicare's District of Workforce Shortage criteria is no surprise to the Burnett Heads community,” he said.

"The Burnett Heads Medical Practice remains empty years after it was fitted out, despite efforts by the Burnett Heads Progress and Sports Association to lobby the federal health minister to change the DWS arrangements so our town can recruit a doctor.

"It is simply not good enough that the Burnett Heads GP Clinic remains empty and it's time to change the DWS arrangements so we can attract a doctor to Burnett Heads.”

Mr McLoughlin said Burnett Heads was not the only township to suffer, with Moore Park Beach in the same predicament.

"The threat of Bundaberg GP clinics closing and the long waiting lists to see local GPs are evidence of a broader issue of DWS funding in the Bundaberg area,” he said.

"The BHPSA has been advocating to the federal health minister through our local MP's office for a change in the DWS arrangements, but unfortunately little has been done to reform a criteria that is clearly proven to be flawed.

"We welcome the new review into the issue, but change is required sooner rather than later as the Burnett Heads community desperately needs a doctor,” he said.

IT'S TIME FOR THE FEDERAL GOVT TO ACT: IWC

THE inadequate supply of GPs in the Bundaberg region will not be resolved until the Federal Government acts on the RRMA (Rural Remote and Metropolitan Areas) scale, which has been stagnating for the past decade and more, says IWC general manager Wayne Mulvany.

There is a serious lack of correlation between the Federal Government's own identification of need in regions and the level of support provided to communities through provision of suitable health care, he said.

"The government's own SEIFA index (Socio-Economic Indexes for Areas) identifies that in Bundaberg region 82.6% of the population is disadvantaged or very disadvantaged. The government's own Department of Social Services has identified Bundaberg as the welfare capital of Australia.

IWC General Manager Wayne Mulvany says the Federal Government must act.
IWC General Manager Wayne Mulvany says the Federal Government must act. SImon Young

"Yet Bundaberg region is rated as RRMA3 on the scale of one (least need) to seven (highest), while Hervey Bay, Maryborough and Gympie are rated as RRMA4, which gives those areas a big advantage around recruitment and retention of GPs.

"It is no wonder that this discrepancy, which directly impacts a medical practice's capacity, means that Bundaberg struggles to attract GPs. IWC is itself a victim of the problem. If our medical centre could attract another five GPs tomorrow, we could fill those books.”

Mr Mulvaney said there was a complete lack of clarity around the calculations behind RRMA rankings.

"It is time for the Federal Government to act,” he said.

IT'S OUTSIDE OUR SCOPE: PHN

PATTIE Hudson, the CEO of Central Queensland, Wide Bay, Sunshine Coast PHN said they were aware of health workforce issues in Bundaberg and were committed to fixing the issue.

She said the PHN was working with Queensland Health and Wide Bay health services to build models in Bundaberg similar to ones already formed in Gympie to address workforce shortages.

Wide Bay's PHN general manager Kath Thompson said the PHN supports general practice by providing information, training and resources.

CEO of Central Queensland, Wide Bay, Sunshine Coast PHN Pattie Hudson said they were aware of health workforce issues in Bundaberg.
CEO of Central Queensland, Wide Bay, Sunshine Coast PHN Pattie Hudson said they were aware of health workforce issues in Bundaberg. contributed

She said the issue of workforce zoning classifications was outside the scope of the PHN.

"Our team of practice support officers helps practices to optimise and improve their business model, data and accreditation standards so they are eligible for applicable Medicare incentives,” she said.

"General practices are private businesses that make decisions based on their business model's ability to make a profit, and while we offer the greatest support possible, we acknowledge that they must make decisions that are best for their business.

"The Right Place Right Time campaign is about informing the local community of their options when it comes to seeking safe and reliable medical advice and treatment.

"If people are finding it difficult to access a local GP they can visit www.rightplacerighttime.com.au.”

The site has a free online symptom checker, the ability to speak to a nurse and find the nearest doctor.

THE RATIO'S FINE: GREG HUNT

BUNDABERG isn't included in the District of Workforce Shortage because the ratio of patients to GPs is about 793, better than the national ratio of 993 per GP, a spokesman from Minister for Health Greg Hunt's office said.

The spokesman said both Maryborough and Hervey Bay were also not classified DWS.

He confirmed Bundaberg, as a regional town with a population more than 70,000, was classified as being RRMA3, while both Hervey Bay and Maryborough were RRMA4.

Federal Health Minister Greg Hunt.
Federal Health Minister Greg Hunt. LUKAS COCH

"While there is no discretion for the Minister to change these, the Minister is deeply aware of and sympathetic to the concerns raised by Keith Pitt,” he said.

"In that context, the DWS system will be reviewed by the Distribution Working Group established under Assistant Minister Gillespie's Rural Roundtable.

"Health Workforce Queensland is funded to assist rural communities to recruit and retain health professionals and is aware of Bundaberg's recruitment issues.”

IN TALKS: ASSISTANT MINISTER DAVID GILLESPIE

ASSISTANT Minister David Gillespie said he had been in discussions with Member for Hinkler Keith Pitt, who had been a strong advocate in pursuing this and other health-related issues in Bundaberg and the broader Hinkler electorate.

"I have had a number of discussions with my close colleague, Keith Pitt, who has been a very strong advocate in pursuing this and other health-related issues in Bundaberg and the broader Hinkler electorate.

"A District of Workforce Shortage is an area identified as having below average access to services attracting a Medicare rebate,” Dr Gillespie said.

Federal Assistant Rural Health Minister Dr David Gillespie.
Federal Assistant Rural Health Minister Dr David Gillespie. Allan Reinikka ROK270916ahealth1

"The DWS system is updated annually in the month of February, using the latest Medicare and population statistics.

"When determining DWS, the department compares the Full Service Equivalent GP-to-population ratio for each DWS Assessment Area.

"Bundaberg is classified as not being a DWS as, according the latest Medicare billing and population data, it has a better GP to population ratio than the national ratio. Both Maryborough and Hervey Bay are also not considered DWS for this reason.

"I have convened a Distribution Working Group that will assess and consider mechanisms to encourage an equitable distribution of the health workforce. Given the apparent differences that exist between these three centres, I will ask the Distribution Working Group to consider these matters and report back to me with potential solutions.”



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